Asians and Pacific Islanders as a whole bear a disproportionate burden of diabetes, both in terms of higher prevalence and rates of diabetes-related complications. Asian and Pacific Islander populations are the fastest growing populations in the United States (US), increasing by 43 percent and 35 percent respectively during the past decade. Despite obvious and important differences among Asian and Pacific Islander subgroups, the relatively small size of these populations included in diabetes studies has resulted in the lumping of these heterogeneous populations of Asian groups and Pacific Islanders in diabetes studies, masking potentially important differences. The study of these groups is also complicated by a relatively high proportion of individuals with mixed race/ethnicity. As a consequence, little is known about diabetes prevalence, treatment patterns and outcomes among Asian and Pacific Islander (API) populations, or importantly, about underlying factors contributing to differences among these populations. Diabetes prevalence, and particularly outcomes, is influenced by many individual, treatment and environmental factors. The objective of this study is to utilize electronic medical record (EMR) data, patient survey data and geocoded census data to comprehensively assess differences in diabetes prevalence, intermediate clinical outcomes and prevalence of diabetes-related complications among ten well-defined populations in a large integrated health care system in Hawaii. The ten populations studied will include: Japanese; Chinese; Filipino, Hawaiians; Samoans; mixed Asian+Caucasian; mixed Asian+Hawaiian; mixed Hawaiian and Caucasian; and mixed Asian+Hawaiian+Caucasian. A Caucasian-only group will also be included for purposes of comparison. The study will focus on a series of variables known to be important influences in diabetes prevalence and outcomes in each of three broad domains: individual factors; treatment factors; and environmental factors. The specific aims of the study are to: 1. Describe differences in diabetes prevalence, intermediate clinical outcomes and complications among these Asian and Pacific Islander populations; and 2. Identify the most important contributing factors to observed differences among these populations within a series of individual, treatment and environmental factors. The results of this study will provide important information about the underlying causes of disparities among a rapidly growing segment of the US population, with findings potentially relevant to other minority populations, and have practical utility in the strategic design of targeted interventions to achieve optimal outcomes for diabetes among Asian and Pacific Islander populations.